Compliance Lead (Pharmacy)
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The Compliance Lead (Pharmacy) ensures compliance with governmental requirements. You will work within specific guidelines and procedures; apply advanced technical knowledge to solve complex problems; receive assignments in the form of objectives and determine approach, resources, schedules and goals. Your decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving your own departmental area. These projects and initiatives will require cross departmental collaboration. Additionally, you conduct briefings and area meetings; you also maintain frequent contact with other compliance associates across the department. You will report directly to the Associate Director of Compliance. You will support the entire Pharmacy Compliance team in areas including our PBM (Pharmacy Benefit Manager) operations, specialty and mail-order dispensing, and key delegated partners.The Compliance Lead (Pharmacy) develops and implements compliance policies and procedures for Medicare Part B and D.
Research compliance issues, interpret and recommend changes that ensure compliance with contract obligations and regulator guidance.
Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external partners to support Pharmacy including Medicare Part D with support of Associate Director.
Assist in the development of strategy and provide ongoing oversight and monitoring of Pharmacy performance including Medicare Parts B and D and related areas, to ensure full compliance and minimize risk for the Enterprise.
Assist the Associate Director and Manager in the completion of risk assessments, with latitude in shaping annual work plans to audit and monitor pharmacy performance of areas within the scope of the position for Medicare Parts B and D.
Complete work functions in assigned areas such as the Medicare Prescription Payment Plan, Integrated Dual Eligible Special Needs Plans (AIP D-SNP), new implementations/CMS initiatives and interpreting complex regulatory guidance to advise pharmacy aligned business areas.
Audit and monitor pharmacy and Medicare Part D programs and performance and report to Regulatory Compliance (RC) leadership top risks, remediation plans and other information.
Participate in regulator audits, working with business partners, First-line Risk and other RC teams.
Maintain relationships with government agencies and participate in audits with regulators, coordinate implementation and compliance with corrective action plans.
Communicate with and present to outside regulators.
Collaborate with the team to review and analyze regulatory and sub-regulatory documents and data, identifying materials that demonstrate compliance with regulatory standards.
Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts.
Work on assignments involve complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Perform assessments, develop action plans, and provide guidance to internal business units.
Build relationships with pharmacy business units.
Provide support for the Manager and Senior associates within the team.
Use your skills to make an impact
Required Qualifications
Bachelor's degree.
Five (5) years of pharmacy experience in claims operations.
Four (4) or more years of experience working in a compliance-related, risk management and/or managed care-related field.
Four (4) or more years interpreting complex regulatory guidance.
Experience in auditing and consulting.
Experience working with regulatory agencies, including CMS and/or state departments of health insurance.
Knowledgeable in regulations governing health care industries.
Knowledge of PBM (Pharmacy Benefit Manager) operations.
Demonstrated ability to interpret and translate guidance to various audiences in a highly matrixed setting.
Highly effective communicator with the ability to influence decision-making and build alignment across diverse stakeholders.
Preferred Qualifications
PharmD, Juris Doctorate, or master's degree.
Certification in healthcare compliance (CHC, CCEP) or similar.
Additional Information
Workstyle: This position is remote; however, candidates residing in and around the Louisville, KY area may have the option to work in a hybrid home/office arrangement.
Travel: Up to 5% travel may be required, including occasional travel outside your state of residence, to support participation in regulatory audits.
Typical Workdays and Hours: Monday – Friday; 8:30am – 5:00pm Eastern Standard Time (EST) with some flexibility.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 09-17-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
